Nursing Key to NICU Outcomes

(MedPageToday) Very low birth weight infants born in hospitals awarded recognition for nursing excellence fared better than those born in hospitals without this rating, a cohort study found.

The mean 7-day mortality rate for infants in hospitals with nursing excellence ratings was 7% compared with 7.4% in other hospitals, for an adjusted odds ratio of 0.87 (95% CI 0.76 to 0.99, P=0.04), according to Eileen T. Lake, PhD, of the University of Pennsylvania in Philadelphia, and colleagues.

Rates also were lower for nosocomial infections (OR 0.86, 95% CI 0.75 to 0.99,P=0.04) and for severe intraventricular hemorrhage (OR 0.88, 95% CI 0.77 to 1,P=0.045), the researchers reported in the April 25 Journal of the American Medical Association.

The American Nurses Credentialing Center has developed a multifaceted program for assessing quality of care.

“Organizations are evaluated for evidence of achieving five program elements: transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and empirical outcomes,” Lake and colleagues explained.

In order to achieve recognition of nursing excellence (RNE), a hospital must conduct a self-evaluation to identify areas of need, implement adaptations as needed, and then be evaluated by outsiders.

Only 7% of U.S. hospitals overall currently carry the RNE rating, as do 20% of centers with neonatal intensive care units (NICUs).

The effect of the nurse excellence rating on infants at risk has not yet been fully examined, so the researchers analyzed data from 558 hospitals participating in the Vermont Oxford Network, which is a network of centers with NICUs that are committed to improving outcomes for newborns.

The analysis included 72,235 infants whose mean birth weight was 1,056 g and whose gestational age was slightly over 28 weeks.

In an editorial that accompanied the article, Wanda D. Barfield, MD, of the CDC in Atlanta, noted that the benefits associated with birth in nursing excellence-rated hospitals were smaller than might have been predicted.

“This may be because all hospitals in the study, both RNE and non-RNE, voluntarily participated in quality improvement activities through the Vermont Oxford Network,” Barfield wrote.

Because this collaborative emphasizes high quality NICU care, even non-RNE hospitals in the network may provide superior neonatal care but might not have met all the stringent hospital-wide criteria for RNE, Barfield noted.

Lake and colleagues also acknowledged that restriction of their analysis to the collaborative network, with its emphasis on quality care for at-risk infants, limits how representative their findings are.

The researchers also pointed out that accessibility to high-quality care for infants at risk remains problematic. “This is a particular source of concern for racial and ethnic minorities because disproportionately few minority infants are born in hospitals with RNE,” they observed.